Provider Demographics
NPI:1558675967
Name:MINOR, JENNIFER (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 N SANTA CRUZ AVE # 181
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5300
Mailing Address - Country:US
Mailing Address - Phone:408-354-5588
Mailing Address - Fax:
Practice Address - Street 1:1848 SARATOGA AVE BLDG 5A
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6613
Practice Address - Country:US
Practice Address - Phone:408-354-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist